NAME OF DRUG
diazepam

CLASSIFICATION

Anxiolytic-sedative, Muscle relaxant

ALTERNATE NAME

VALIUM, VIVOL

INDICATIONS

• acute anxiety or tension states
• alleviation of symptoms of acute alcohol withdrawal
• recurrent convulsive seizures and status epilepticus
• premedication for anesthesia, cardioversion or endoscopy

RECONSTITUTION AND STABILITY

• for IV intermittent or IV infusion, the drug MUST BE DILUTED to a maximum concentration of 1 mg/10 mL with a compatible diluent to avoid precipitation
• stable in glass containers for 24 hours
• infusion sets with an auxiliary chamber should not be used since they may absorb significant amounts of the drug
• if prepared in plastic minibags, administer as soon as possible to minimize absorption of drug to plastic surfaces

COMPATIBILITY

• compatible with NS, D5W, RS, LR
• incompatible with other drugs

• IM
  • not recommended (absorption is delayed, unpredictable and irritating to tissue) exception:  when oral or IV routes are not feasible, inject deeply into the muscle
• IV direct
  • into a large vessel (e.g. antecubital vein) at a rate not exceeding 5 mg/minute
  • administered through Microbore 2Y extension set
  • administration into tubing of a running IV is not recommended
• IV intermittent, IV infusion - only if necessary
  • only the diluted solution (max. 1 mg/10 mL) may be administered by this route

VH & HSC ADMINISTRATION POLICY

IV infusions restricted to critical care areas

E - Direct IV route can be administered by nurses on general nursing units provided a venous access has been established, and according to policies and recommendations stated in this manual.

H - The IV infusion rate MUST be controlled by an automated infusion control device.

DOSAGE

• individualized according to indication, patient's requirements and response

Adults:

Acute anxiety, alcohol withdrawal, premedication

IV: 

• 2-20 mg
• injection may be repeated hourly, although every 3-4 hours may be satisfactory

Status epilepticus: 

• 5-10 mg by direct IV; repeat if necessary every 10-15 minutes until a total of 30 mg has been given; repeat initial dose in 2-4 hours if necessary

Children: IV slowly over three minutes

•     Sedative/Muscle Relaxant: 
  • 0.04-0.2 mg/kg/dose IM/IV q2-4h. Maximum: 0.6 mg/kg within an 8 hour period
    
• Seizures: 
  • 5 yrs or older - 0.3 mg/kg/dose IV to maximum 10 mg or 0.5 mg/kg/dose PR to maximum 10 mg; may repeat if necessary every 10 minutes x 2 (maximum 3 doses

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• thrombophlebitis, pain, desquamation at injection site
• severe hypotension, bradycardia, respiratory depression and cardiac arrest may follow too rapid IV administration

IMPORTANT IMPLICATIONS

• notify physician if respiratory rate falls below 8 per minute
•  DO NOT administer into small veins
•  injectable product may be given rectally
• adverse effects include: sedation, dizziness, vertigo (more pronounced in the elderly), anterograde anmesia, depression and mental confusion
• CNS depressant effects are additive with other concomitantly used CNS depressants
• use with caution in patients with hepatic failure

Rev. Jan 2007